ealth expenditures in the United States neared$2.6 trillion in 2010, accounting for 17.9 percent of the U.S. Gross Domestic Product (GDP)
, with chronicdisease capturing the lion’s share of the cost. Nearly1 out of every 2 adults, or 133 million Americans, hadat least one chronic illness in 2005
, and every year,chronic disease, which includes cancer, diabetes,heart disease and stroke, causes 70 percent of deathsin the U.S. and comprises approximately 75 percentof medical care spend.
The explosion of chronic dis-ease is not just an American phenomenon; it is theleading cause of mortality in the world, responsiblefor 63 percent of all deaths.
In 2008 alone, 36 millionpeople died from chronic disease, according to theWorld Health Organization.
In an effort to bend the cost curve and address chronic condi-tions, leading healthcare organizations have implemented vari-ous solutions. Remote monitoring for chronic disease manage-ment has been widely deployed because it targets the area of greatest spend. It also affords convenience for both patients andclinicians, enabling the former to track and self-manage theirconditions within their daily lives and the latter to receive criticalinformation anywhere and anytime in order to provide real-time
quality care. Numerous studies have quantiﬁed both the clinicaland ﬁnancial value of implementing such programs (See Table 1
and Figures 1-3).
Accountable Care: Changing theDynamics for Managing Chronic Diseases
Despite documented successes, in general remote monitoringfor chronic disease management has been stuck in pilot mode.While there are a handful of reasons for this inertia, the maindriver is lack of economic incentive, according to Donald Jones,vice president of global strategy and market development forglobal telecommunications leader Qualcomm Life. “What really
drives healthcare is when workﬂow can be improved, direct and
measurable costs can be reduced, or market share can be in-creased,” he said. “At the end of the day, quality usually has tobe hand in hand with one of these drivers in order for somethingto be implemented.” As the path to unsustainability grows evershorter, new accountable care models are being developed toreplace the current fee-for-service model, moving from pay forvolume to pay for quality, which contributes to a more receptiveenvironment for remote monitoring.The passage of the Affordable Care Act (ACA) has moved upthe timeline for implementing new payment models. The ACAincorporated provisions for participation in accountable care or-ganizations (ACOs), which tie provider reimbursements to qual-ity metrics and reduced cost for an assigned patient population.Under the Medicare Shared Savings Program, which began inJanuary 2012, participating entities that meet quality and perfor-mance standards are eligible to receive payments for shared sav-ings. Also under ACA, the Hospital Readmission Reduction Pro-
*The largest randomized control trial of telecare and telehealth in the world.Reductions in:Reductions (%)
Figure 3: Results of 3 Million Lives - Whole SystemDemonstrator (UK) trials (2012)*
ElectiveAdmissions14%15%20%45%A&E VisitsEmergencyAdmissionsMortality Rates
*Analysis comparing five independent clinical studies demonstrating the effectiveness of home healthmonitoring across a combined 17,917 patients.
Figure 2: NEHI’s “Detailed Technology Analysis –Home Telehealth” (2009)*
Average Decrease inHospitalizations49%Decrease inMortality RatesAverage Decreasein ED Use69%69%
*Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day ReadmissionRates in a Case-managed Medicare Population, Med Care, 2012**“Virtual Monitoring Reduces Hospital Readmissions for Spectrum Health Heart Patients,” 2010
Figure 1: Reduced Hospital Readmissions UsingRemote Monitoring Solutions
Readmissions Reduction (%)GeisingerHealth Plan*44%SpectrumHealth**73%
1. Centers for Medicare and Medicaid Services2. Rand Health3. Centers for Disease Control and Prevention4. World Health Organization